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Jönsson L, Stenvall A, Mattsson E, Larsson E, Sundlöv A, Ohlsson T, Hindorf C. Correction to: Quantitative analysis of phantom studies of 111In and 68Ga imaging of neuroendocrine tumours. EJNMMI Phys 2022; 9:76. [PMID: 36315296 PMCID: PMC9622970 DOI: 10.1186/s40658-022-00502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- L. Jönsson
- grid.4514.40000 0001 0930 2361Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - A. Stenvall
- grid.4514.40000 0001 0930 2361Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - E. Mattsson
- grid.413253.2Department of Hospital Physics, County Hospital Ryhov, Jönköping, Sweden
| | - E. Larsson
- grid.411843.b0000 0004 0623 9987Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - A. Sundlöv
- grid.4514.40000 0001 0930 2361Department of Oncology and Pathology, Clinical Sciences Lund University, Lund, Sweden
| | - T. Ohlsson
- grid.411843.b0000 0004 0623 9987Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - C. Hindorf
- grid.411843.b0000 0004 0623 9987Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
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Jönsson L, Stenvall A, Mattsson E, Larsson E, Sundlöv A, Ohlsson T, Hindorf C. Quantitative analysis of phantom studies of 111In and 68Ga imaging of neuroendocrine tumours. EJNMMI Phys 2018; 5:5. [PMID: 29460190 PMCID: PMC5818391 DOI: 10.1186/s40658-018-0204-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background Nuclear medicine imaging of neuroendocrine tumours is performed either by SPECT/CT imaging, using 111In-octreotide or by PET/CT imaging using 68Ga-radiolabelled somatostatin analogs. These imaging techniques will give different image quality and different detection thresholds for tumours, depending on size and activity uptake. The aim was to evaluate the image quality for 111In-SPECT and 68Ga-PET imaging, i.e. the smallest volume possible to visualize for different source-to-background activity ratios. The accuracy of quantification of lesion volume and activity was also investigated to develop an objective evaluation for radionuclide therapy eligibility. The phantom study was performed using the NEMA IEC Body Phantom with six hot spheres having inner diameters of 10, 13, 17, 22, 28, and 37 mm, filled with either 68Ga or 111In with sphere-to-background ratios (SBRs) of no background activity, 5:1, 2.5:1, and 1.25:1. Activity ratios of 1.25:1 and 2.5:1 are clinically found for lesions close to the liver and spleen. Clinical acquisition and reconstruction protocols were applied. Line profiles were drawn to evaluate the smallest detectable volume within a given SBR. Recovery curves based on threshold-based VOIs, threshold-based VOIs adapted to the background and CT-based ROIs were obtained for all SBRs and sphere diameters, allowing for quantification. Results The 10-mm sphere was not possible to detect in SPECT images. It was detectable in PET images for SBRs of 2.5:1 and higher. In a background corresponding to the activity uptake in the liver, spheres larger than 22–37 mm were detectable in the 111In-SPECT images and spheres larger than 13–22 mm were detectable in the 68Ga-PET images. The maximum activity concentration was accurately quantified for spheres larger than 22 mm in the PET images; however, the quantification was impaired by sphere size and background activity. Conclusions It was not possible to detect the 10-mm sphere in any of the SPECT images. In a background corresponding to the activity uptake in the liver, spheres larger than approximately 30 mm were visible in the 111In-SPECT images and spheres larger than approximately 17 mm were visible in the 68Ga-PET images. Sphere diameter and background activity strongly affect the possibility of a correct quantification.
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Affiliation(s)
- L Jönsson
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden.
| | - A Stenvall
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - E Mattsson
- Department of Hospital Physics, County Hospital Ryhov, Jönköping, Sweden
| | - E Larsson
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - A Sundlöv
- Department of Oncology and Pathology, Clinical Sciences Lund University, Lund, Sweden
| | - T Ohlsson
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - C Hindorf
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
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Kjørstad K, Baksaas S, Bundgaard D, Halbakken E, Hasselgård T, Jonung T, Jørgensen G, Jørgensen J, Krog A, Krohg-Sørensen K, Laxdal E, Mathisen S, Oskarsson G, Seljeskog S, Settemsdal I, Vetrhus M, Viddal B, Wesche J, Aasgaard F, Mattsson E. The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kjørstad KE, Baksaas ST, Bundgaard D, Halbakken E, Hasselgård T, Jonung T, Jørgensen GT, Jørgensen JJ, Krog AH, Krohg-Sørensen K, Laxdal E, Mathisen SR, Oskarsson GV, Seljeskog S, Settemsdal I, Vetrhus M, Viddal BA, Wesche J, Aasgaard F, Mattsson E. Editor's Choice - The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events. Eur J Vasc Endovasc Surg 2017; 54:415-422. [PMID: 28844552 DOI: 10.1016/j.ejvs.2017.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE/BACKGROUND The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery. METHODS This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated. RESULTS Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p = .008). The combined 30 day mortality and stroke rate was 3.8%. CONCLUSION This national study with almost complete inclusion and follow-up shows that the delays occur mainly at patient level and in hospital. The delay is associated with new neurological events. Dual antiplatelet therapy is associated with reduced risk of having a new neurological event before surgery.
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Affiliation(s)
- K E Kjørstad
- University Hospital of North Norway, Tromsø, Norway.
| | | | | | | | | | - T Jonung
- Haukeland University Hospital, University of Bergen, Bergen, Norway
| | | | - J J Jørgensen
- Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
| | - A H Krog
- Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
| | - K Krohg-Sørensen
- Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
| | - E Laxdal
- Haukeland University Hospital, University of Bergen, Bergen, Norway
| | | | | | - S Seljeskog
- Akershus University Hospital, Lørenskog, Norway
| | | | - M Vetrhus
- Stavanger University Hospital, Stavanger, Norway
| | - B A Viddal
- Stavanger University Hospital, Stavanger, Norway
| | - J Wesche
- University of Oslo, Oslo, Norway; Akershus University Hospital, Lørenskog, Norway
| | - F Aasgaard
- St. Olav's University Hospital, Trondheim, Norway
| | - E Mattsson
- St. Olav's University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Trondheim, Norway
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van Daalen FV, Prins JM, Opmeer BC, Boermeester MA, Visser CE, van Hest RM, Branger J, Mattsson E, van de Broek MFM, Roeleveld TC, Karimbeg AA, Haak EAF, van den Hout HC, van Agtmael MA, Hulscher MEJL, Geerlings SE. Effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: a stepped wedge cluster randomized trial. Clin Microbiol Infect 2017; 23:485.e1-485.e8. [PMID: 28159671 DOI: 10.1016/j.cmi.2017.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Quality indicators (QIs) have been developed to define appropriate antibiotic use in hospitalized patients. We evaluated whether a checklist based on these QIs affects appropriate antibiotic use and length of hospital stay. METHODS An antibiotic checklist for patients treated with intravenous antibiotics was introduced in nine Dutch hospitals in a stepped wedge cluster randomized trial. Prophylaxis was excluded. We included a random sample before (baseline), and all eligible patients after (intervention) checklist introduction. Baseline and intervention outcomes were compared. Primary endpoint was length of stay (LOS), analysed by intention to treat. Secondary endpoints, including QI performances, QI sum score (performance on all QIs per patient), and quality of checklist use, were analysed per protocol. RESULTS Between 1 November 2014 and 1 October 2015 we included 853 baseline and 5354 intervention patients, of whom 993 (19%) had a completed checklist. The LOS did not change (baseline geometric mean 10.0 days (95% CI 8.6-11.5) versus intervention 10.1 days (95% CI 8.9-11.5), p 0.8). QI performances increased between +3.0% and +23.9% per QI, and the percentage of patients with a QI sum score above 50% increased significantly (OR 2.4 (95% CI 2.0-3.0), p<0.001). Higher QI sum scores were significantly associated with shorter LOS. Discordance existed between checklist-answers and actual performance. CONCLUSIONS Use of an antibiotic checklist resulted in a significant increase in appropriateness of antibiotic use, but not in a reduction of LOS. Low overall checklist completion rates and discordance between checklist-answers and actual provided care might have attenuated the impact of the checklist.
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Affiliation(s)
- F V van Daalen
- Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, The Netherlands.
| | - J M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, The Netherlands
| | - B C Opmeer
- Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - C E Visser
- Department of Microbiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - R M van Hest
- Department of Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Branger
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - E Mattsson
- Department of Medical Microbiology, Reinier de Graaf, Delft, The Netherlands
| | - M F M van de Broek
- Department of Internal Medicine, Antoniusziekenhuis, Nieuwegein, The Netherlands
| | - T C Roeleveld
- Department of Internal Medicine, Spaarnegasthuis, Hoofddorp, The Netherlands
| | - A A Karimbeg
- Department of Internal Medicine, Westfriesgasthuis, Hoorn, The Netherlands
| | - E A F Haak
- Department of Hospital Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - H C van den Hout
- Department of Internal Medicine, Spaarnegasthuis, Haarlem, The Netherlands
| | - M A van Agtmael
- Department of Internal Medicine, Division of Infectious Diseases, VU Medical Centre, Amsterdam, The Netherlands
| | - M E J L Hulscher
- Department of Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, The Netherlands
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Kjørstad K, Baksaas S, Bundgaard D, Halbakken E, Hasselgård T, Jørgensen G, Krog A, Krohg-Sørensen K, Laxdal E, Mathisen S, Oskarsson G, Seljeskog S, Settemsdal I, Viddal B, Aasgaard F, Mattsson E. The National Norwegian Carotid Study; Time From Symptom Debut To Surgery is Too Long, Giving Additional Neurological Events. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Halldorsdottir H, Nordström J, Brattström O, Sennström MM, Sartipy U, Mattsson E. Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement. Int J Obstet Anesth 2015; 26:75-8. [PMID: 26775895 DOI: 10.1016/j.ijoa.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/24/2015] [Accepted: 11/29/2015] [Indexed: 11/30/2022]
Abstract
Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.
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Affiliation(s)
- H Halldorsdottir
- Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden; Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - J Nordström
- Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden
| | - O Brattström
- Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Sweden; Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - M M Sennström
- Department of Obstetrics and Gynecology, Karolinska University Hospital Solna, Sweden
| | - U Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital Solna, Sweden
| | - E Mattsson
- Department of Cardiology, Karolinska University Hospital Solna, Sweden
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Breuer S, Fogelstrand P, Lindskog H, Osterberg K, Luebke T, Brunkwall J, Mattsson E. Introduction of embryonic stem cells into vein grafts reduces intimal hyperplasia in mice. J Cardiovasc Surg (Torino) 2014; 55:235-246. [PMID: 23369946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Atherosclerosis with its cardiovascular events including cardiac and peripheral ischemia represents the main cause of death in the developed countries. Although interventional treatments like percutaneous transluminal angioplasty or stents are increasingly applied for the treatment of peripheral arterial disease, they are not always technically applicable or durable and bypass surgery is needed. Compared to synthetic grafts, vein grafts show a better patency especially when used for the lower leg as well as a lower risk for infection compared to synthetic grafts. Still the long-term patency rates are unsatisfactory due to accelerated intimal hyperplasia, a thickening of the vessel wall. The aim of this study was to elucidate, if the implantation of embryonic stem cells into vein grafts can reduce the development of intimal hyperplasia in a mouse in vivo model. METHODS In this study we implanted LacZ-tagged (ROSA26) murine embryonic stem cells into decellularized vein grafts. Control groups were: 1) untreated veins; 2) decellularized veins; 3) decellularized veins with gel and plastic film; and 4) decellularized veins with smooth muscle cells in gel surrounded by plastic film. Six weeks after insertion into the carotid artery of mice, the grafts were excised and analyzed immunohistochemically, morphologically, and by x-gal staining and compared to the control groups. The Mann-Whitney U test was used to compare groups. Statistical significance was indicated by a value of P<0.05. RESULTS Decellularized veins with implanted stem cells showed significantly less intimal thickening compared to all control groups (intimal hyperplasia vs. luminal circumference mean±SD 7.3±3.5 µm, median 8 µm). The control groups: 1) untreated veins (60.3±25.5 µm, median 58.5 µm); 2) decellularized veins (53.9±22.4 µm, median 48.4 µm); 3) decellularized veins with gel and plastic film (70.6±22.4 µm, median 72.6 µm); and 4) decellularized veins with smooth muscle cells in gel surrounded by plastic film (73.5±18.1 µm, median 73.6 µm) all showed the same high degree of intimal hyperplasia. CONCLUSION This study demonstrates that embryonic stem cells have a therapeutic competence to favourably modulate intimal hyperplasia in vivo.
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MESH Headings
- Animals
- Biomarkers/metabolism
- Carotid Artery, Common/pathology
- Carotid Artery, Common/surgery
- Cell Line
- Embryonic Stem Cells/metabolism
- Embryonic Stem Cells/transplantation
- Genes, Reporter
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/metabolism
- Graft Occlusion, Vascular/pathology
- Graft Occlusion, Vascular/prevention & control
- Hyperplasia
- Male
- Mice
- Mice, 129 Strain
- Neointima
- Time Factors
- Transfection
- Vascular Grafting/adverse effects
- Vascular Grafting/methods
- Vena Cava, Inferior/metabolism
- Vena Cava, Inferior/pathology
- Vena Cava, Inferior/transplantation
- beta-Galactosidase/biosynthesis
- beta-Galactosidase/genetics
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Affiliation(s)
- S Breuer
- Department of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany -
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Lange C, Aasland J, Ødegård A, Hatlinghus S, Winnerkvist A, Mattsson E, Myhre HO. Endovascular treatment of descending thoracic aortic disease. A single center experience. INT ANGIOL 2013; 32:581-588. [PMID: 24212291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Aim of the study was to assess if endovascular treatment is a feasible alternative in patients with descending thoracic aortic disease. METHODS Seventy-three patients were admitted for stent-grafting of descending thoracic aortic disease during the period 1997-2008. The majority of the patients had aneurysm (35) or type B dissection (21), but also traumas, penetrating ulcers and other conditions were treated. Sixteen (22%) were unfit for open surgery. Thirty-four (47%) of the patients were symptomatic and 18 had rupture. The primary technical success rate was 96%. RESULTS Early mortality (<30 days) for the whole group was 3%. Early endoleak (<30 days) was identified in 11 patients (15%) of whom 4 (5%) had a secondary procedure. In addition, two trauma patients required insertion of a new stent-graft due to stent-graft collapse. Two patients had stroke, one had paraplegia and two paraparesis. Mean follow-up was 3.1 years (range 0-12 years). Late endoleak (>30 days) was identified in 5 patients (7%) treated by 6 secondary procedures. One patient (1.7%) had an explant. Two patients have had extensions of endografts due to increasing diameter of the aorta at the distal end of the stent-graft. CONCLUSION Endovascular treatment seems to be a viable alternative in patients with descending thoracic aortic disease.
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Affiliation(s)
- C Lange
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway -
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Johansson B, Engstrom KG, Dellborg M, Kronvall T, Kvidal P, Mattsson E, Thilen U. Functional class, symptoms, medications, arrhythmia devices and quality of life in adults with congenital aortic valve disease. Data from the national registry of congenital heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Roaldsen KS, Elfving B, Stanghelle JK, Mattsson E. Effect of multilayer high-compression bandaging on ankle range of motion and oxygen cost of walking. Phlebology 2012; 27:5-12. [PMID: 21810941 PMCID: PMC3257002 DOI: 10.1258/phleb.2011.010084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effects of multilayer high-compression bandaging on ankle range of motion, oxygen consumption and subjective walking ability in healthy subjects. METHOD A volunteer sample of 22 healthy subjects (10 women and 12 men; aged 67 [63-83] years) were studied. The intervention included treadmill-walking at self-selected speed with and without multilayer high-compression bandaging (Proforeº), randomly selected. The primary outcome variables were ankle range of motion, oxygen consumption and subjective walking ability. RESULTS Total ankle range of motion decreased 4% with compression. No change in oxygen cost of walking was observed. Less than half the subjects reported that walking-shoe comfort or walking distance was negatively affected. CONCLUSION Ankle range of motion decreased with compression but could probably be counteracted with a regular exercise programme. There were no indications that walking with compression was more exhausting than walking without. Appropriate walking shoes could seem important to secure gait efficiency when using compression garments.
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Affiliation(s)
- K S Roaldsen
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 23100, SE-14183 Huddinge, Sweden.
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Engvall G, Mattsson E, von Essen L, Hedström M. Findings on how adolescents cope with cancer--a matter of methodology? Psychooncology 2010; 20:1053-60. [PMID: 20669336 DOI: 10.1002/pon.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 06/10/2010] [Accepted: 06/10/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The various conclusions drawn from previous studies on how adolescents cope with cancer might partly be explained by methodological issues. The aim was to explore how adolescents recently diagnosed with cancer report that they cope with disease- and treatment-related distress in response to closed- and open-ended questions, respectively. METHODS Adolescents diagnosed with cancer 4-8 weeks ago (N=56) answered closed- and open-ended questions over the telephone about which coping strategies they use to cope with physical concerns, personal changes, feelings of alienation, and worries. RESULTS In response to closed-ended questions, most adolescents reported using emotion-focused coping (Accepting and Minimising) while, in response to open-ended questions, meaning-based (i.e. Positive thinking) and problem-focused (i.e. Problem solving) coping were most often mentioned. A majority reported using Minimising and Seeking support in response to closed-ended questions, but very few adolescents mentioned using these strategies in response to open-ended questions. CONCLUSIONS Adolescents' reports of how they cope with disease- and treatment-related distress vary depending on antecedent closed- and open-ended questions. Responses to closed-ended questions appear to be more indifferent to aspects of distress than responses to open-ended questions. Strategies representing meaning-based coping should be included in future studies investigating how adolescents recently diagnosed with cancer cope with disease- and treatment-related distress.
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Affiliation(s)
- G Engvall
- Department of Public Health and Caring Sciences, Psychosocial Oncology and Supportive Care, Uppsala University, Sweden.
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Pedersen G, Laxdal E, Ellensen V, Jonung T, Mattsson E. Improved patency and reduced intimal hyperplasia in PTFE grafts with luminal immobilized heparin compared with standard PTFE grafts at six months in a sheep model. J Cardiovasc Surg (Torino) 2010; 51:443-448. [PMID: 20523297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM The aim of this study was to compare the performance of polytetrafluoroethylene (PTFE) grafts with luminal coating of immobilized heparin to that of standard PTFE grafts at six months. METHODS Twenty-eight common carotid arteries in fourteen sheep were bypassed with heparin-coated PTFE grafts (6 mm diameter, 6 cm length) on one side and standard PTFE grafts on the other. The grafts were explanted after six months. The thickness of intimal hyperplasia (IH) in open grafts was measured with histomorphometrical methods. RESULTS Two of 14 heparinized PTFE grafts and nine of 14 grafts in the control PTFE-group were occluded at explantation (P=0.006). Six-month patency rates for heparinized PTFE grafts and for standard PTFE grafts were 86% and 36%, respectively. Mean graft anastomotic IH thickness in open grafts were 0.074 mm for heparinized PTFE grafts and 0.259 mm for PTFE-grafts (P=0.006). CONCLUSION PTFE grafts with luminal coating containing immobilized heparin had significantly better patency and recruited less intimal hyperplasia than standard PTFE grafts at six months.
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Affiliation(s)
- G Pedersen
- Surgical Clinic, Haukeland University Hospital, Bergen, Norway.
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Radell U, Tillberg E, Mattsson E, Åmark P. Postnatal cerebral infection leading to hemiplegic cerebral palsy: Functional limitations and disability of 13 children in Sweden. Disabil Rehabil 2009; 30:1910-9. [DOI: 10.1080/09638280701673641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Radell U, Tillberg E, Mattsson E, Amark P. Participation in age-related activities and influence of cultural factors–comments from youth and parents of children with postnatal post infectious hemiplegia in Stockholm, Sweden. Disabil Rehabil 2009; 30:891-7. [PMID: 17852276 DOI: 10.1080/09638280701403999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate whether children with postnatal post-infectious hemiplegic cerebral palsy, and their parents, felt that participation in activities typical for the child's age and gender was affected. To identify factors, intra- and extra-personal that influenced disability with emphasis on factors related to immigration. METHOD Interviews with six youths and 15 caregivers regarding the child's ability to participate in age-related activities, the consequences of disability in their home country compared to Sweden, and whether immigration influenced being a parent to a disabled child. RESULTS All reported large difficulties participating in age-related activities. Positive and negative differences in participation in different cultures were described. War, culture, eating habits, hygiene habits, and school could differ and create difficulties when in Sweden. Language skills and intra personal factors influenced information gathering and participation in parental activities. CONCLUSIONS Surprisingly large difficulties in participation may separate those with a postnatal post-infectious aetiology from hemiplegia of other aetiologies. High degrees of additional impairments may influence participation more than the physical disability. Language skills and cultural factors influence ability to seek and gain information. A mutual process where both Swedes and immigrants know traditions of care for disabled in both places may create understanding and improved dialogue.
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Affiliation(s)
- U Radell
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden.
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Abstract
The aim was to investigate whether there are any positive consequences of childhood cancer. Studies published 1990-2005 reporting survivors' descriptions of positive consequences of childhood cancer were identified through a search in the databases CINAHL, PsycINFO, and PubMed. According to a manifest content analysis, positive consequences were referred to three themes: life values, relations to others, and relation to self. A second search in the same databases was conducted to identify studies investigating whether survivors of childhood cancer differ from comparison groups with regard to variables assigned to these themes. In these studies, no conclusions about positive consequences with regard to the theme life values can be drawn, as only one study was identified. In addition, only a small minority of findings from comparative studies indicate that childhood cancer has any positive consequences with regard to relations to others and relation to self. A majority of the results indicate that survivors do not differ from comparison groups, whereas some findings highlight that friendship and marital status are areas of concern, and parenthood and sexuality are areas of potential concern. It is recommended that survivors of childhood cancer are followed up by a multi-professional team, focusing not only on the survivors' health status but also on relations to family, friends, and partners.
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Heckenkamp J, Mellander S, Fogelstrand P, Breuer S, Brunkwall J, Mattsson E. Photodynamic Therapy Reduces Intimal Hyperplasia in Prosthetic Vascular Bypass Grafts in a Pig Model. Eur J Vasc Endovasc Surg 2007; 34:333-9. [PMID: 17513141 DOI: 10.1016/j.ejvs.2007.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 04/01/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bypass surgery has a failing frequency of 30% during the first year, mainly due to intimal hyperplasia (IH). This negative effect is most pronounced in artificial grafts. Photodynamic therapy (PDT) is a technique in which light activates photosensitizer dyes to produce free-radicals resulting in an eradication of cells in the vascular wall. The aim of this study was to determine the effectiveness of PDT to reduce IH in a preclinical porcine PTFE bypass model. MATERIAL AND METHODS Ten pigs were used. After a pilot PDT dosimetry study (n=3) PTFE grafts were bilaterally placed into the circulation as bypasses from the common to the external iliac arteries (n=7). The right sides served as controls (C). Before implantation of the left grafts, the arterial connecting sites of the left distal anastomoses were PDT-treated. The arteries were pressurized at 180 mmHg for 5 minutes with the photosensitizer Methylene Blue (330 microg/ml), and thereafter endoluminally irradiated with laser light (lambda = 660 nm, 100 mW/cm(2), 150 J/cm(2)). After 4 weeks the specimens were retrieved and formalin fixed. Cross sections through the midportions of the distal anastomoses and the grafts were used for histology, immunohistochemistry to identify inflammatory cells and morphometric evaluation (n=7). RESULTS No systemic side effects and no graft occlusions were noted. PDT-treated anastomoses showed reduced IH in the mid-portions of the anastomoses (Area of IH: microm(2)/microm graft: C: 6970+/-1536, PDT: 2734+/-2560; P<0.005) as well as in the grafts (C: 5391+/-4031, PDT: 777+/-1331; P<0.02). The number of inflammatory cells per microscopic field was increased after PDT (C: 24+/-16, PDT: 37+/-15; P<0.009). CONCLUSIONS Adjuvant PDT, performed in an endovascular fashion, was a safe method to reduce prosthetic graftstenosis in a preclinical setting. This study underscores the clinical potential of PDT to inhibit the development of clinical bypass graftstenosis.
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Affiliation(s)
- J Heckenkamp
- Division of Vascular Surgery, Department of Vascular and Visceral Surgery, University of Cologne, Cologne, Germany.
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Abstract
AIM To describe age and gender differences in estimated maximum oxygen uptake (VO2max) and participation in organized physical activity in Swedish obese children and adolescents, and compare the results with an age-matched reference group representative of the general population. METHODS Two hundred and nineteen obese children (102 boys, 117 girls, aged 8-16 years, Body Mass Index (BMI) 24.3-57.0 kg.m-2) performed a submaximal bicycle ergometry test and an interview concerning participation in organized physical activity. RESULTS The obese children had lower relative VO2max (p<0.001) than the reference group. In contrast to the reference group no age or gender differences were detected in the obese children aged 11-13 years and 14-16 years. With increased age (after 11 years) the obese children participated less in organized physical activity than the reference group (p<0.001). In obese adolescents, participation in organized physical activity in leisure time explained 7% and BMI 45% of the variance in relative VO2max. CONCLUSION The obese children had lower relative VO2max, and participated less in organized physical activity than the reference group. The variance in relative VO2max was primarily explained by BMI. Obese adolescents, especially boys, were found to be at risk of physical inactivity.
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Affiliation(s)
- G Berndtsson
- Karolinska Institutet, Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Huddinge, and Karolinska University Hospital, SE 141 86 Huddinge and SE 171 76 Solna, Sweden.
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Zhang J, Krishnan R, Arnold CS, Mattsson E, Kilpatrick JM, Bantia S, Dehghani A, Boudreaux B, Gupta SN, Kotian PL, Chand P, Babu YS. Discovery of highly potent small molecule kallikrein inhibitors. Med Chem 2007; 2:545-53. [PMID: 17105435 DOI: 10.2174/1573406410602060545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Uncontrolled kallikrein activation is involved in diseases such as hereditary angioedema, bacterial septic shock and procedures such as cardiopulmonary bypass. Here we report a series of small molecule compounds that potently inhibit kallikrein activity in vitro. Kinetic studies indicate that some of these compounds are slow binding inhibitors of kallikrein with Ki final less than a nanomolar. The ability of these compounds to inhibit the activity of kallikrein was further confirmed in a plasma model by quantitating the release of bradykinin, an endogenous cleavage product of plasma kallikrein. To understand the inhibitory mechanism of the selected compounds toward kallikrein, the interactions between the selected compounds and kallikrein was explored using molecular modeling based on the information of crystal structures of TF/FVIIa and kallikrein. The information presented in the current study provides an initial approach to develop more selective and therapeutically useful small molecule inhibitors.
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Affiliation(s)
- J Zhang
- Biology Department, BioCryst Pharmaceuticals, Inc. 2190 Parkway Lake Drive, Birmingham, Alabama 35244, USA.
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Mattsson E, Ringnér A, Ljungman G, von Essen L. Positive and negative consequences with regard to cancer during adolescence. Experiences two years after diagnosis. Psychooncology 2007; 16:1003-9. [PMID: 17266181 DOI: 10.1002/pon.1162] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose was to explore negative and positive consequences of cancer during adolescence experienced two years after diagnosis. METHODS Two years after diagnosis 38 persons, 15-21 years old, were asked two questions over the telephone: What, if anything, is bad for you due to the cancer disease? and What, if anything, is good for you due to the cancer disease? The answers were analysed by content analysis. RESULTS Four categories of negative experiences were identified: a problematic body; unpleasant thoughts and feelings; outside the circle of friends; and difficulties with schoolwork. Six categories of positive experiences were identified: a more positive view of life; good self-esteem; knowledge and experience with regard to disease and hospital care; good relations; broader perspectives; and material gains. CONCLUSIONS Two years after diagnosis those struck by cancer during adolescence experience not only a number of negative, but also positive, consequences of the cancer disease and its treatment.
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Affiliation(s)
- E Mattsson
- Department of Public Health and Caring Sciences, Psychosocial Oncology, Uppsala University, Uppsala, Sweden.
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Raustorp A, Mattsson E, Svensson K, Ståhle A. Physical activity, body composition and physical self-esteem: a 3-year follow-up study among adolescents in Sweden. Scand J Med Sci Sports 2006; 16:258-66. [PMID: 16895531 DOI: 10.1111/j.1600-0838.2005.00483.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To measure physical activity by means of daily pedometer steps, body composition, expressed as body mass index (BMI) and bioelectrical impedance as percent body fat, and perceived physical self-esteem and additionally, to evaluate eventual predictors for a healthy lifestyle i.e., highly physically active, normal weighted and a high physical self-esteem in a follow-up group. METHODS During autumn 2000 physical activity level was assessed and BMI was calculated in 871 children aged 7-14 in south eastern Sweden and in 501 of these, physical self-esteem were also assessed. During autumn 2003 a total of 375 adolescents aged 15-18 were assessed using the same methodology and additionally percent body fat was measured. Ninety-three of these adolescents (46 girls), were also measured in 2000 and they formed the follow-up group. RESULTS In the follow-up group a significant increase in BMI and stability in physical self-esteem in boys and girls, and in boys a significant decrease in daily steps was found 3 years later. Strongest predictor to be highly physically active, maintain normal BMI and high self-esteem 3 years later, i.e., to have a healthy lifestyle, was for girls increased self-esteem and for boys a decreased BMI. CONCLUSION Consequently, for a healthy lifestyle, promoting physical self-esteem in girls and weight control in boys is of great importance in early adolescence.
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Affiliation(s)
- A Raustorp
- Department of Health and Behavioural Science, Division of Physical Education, University of Kalmar, Kalmar, Sweden.
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Mellander S, Fogelstrand P, Enocson K, Johansson BR, Mattsson E. Healing of PTFE Grafts in a Pig Model Recruit Neointimal Cells from Different Sources and Do Not Endothelialize. Eur J Vasc Endovasc Surg 2005; 30:63-70. [PMID: 15933985 DOI: 10.1016/j.ejvs.2005.02.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the cellular sources for the neointima and the cell type that is lining the lumen in artificial grafts implanted in pigs. MATERIALS AND METHODS We used polytetrafluoroethylene grafts as bypasses from the common to the external iliac arteries. The animals were sacrificed after 1, 4, 7, 14, 21, 30, 60 and 90 days. Morphological, immunohistochemical and electron microscope assessments were made. RESULTS After 7 days a circumferential neoadventitia was formed. At day 14 isolated cellular islets of proliferating cells were observed on the luminal side of the graft without connection to the neoadventitia or the adjacent arteries. In the anastomotic regions at day 14 we observed an isolated neointima in contact with the adjacent artery. The cells lining the lumen had characteristics of both smooth muscle cells and endothelial cells. CONCLUSIONS Our study suggests that in artificial porcine grafts, the perivascular tissue, the blood and the adjacent artery contribute to the formation of the neointima. The luminal surface is covered by a hybrid cell with both smooth muscle cell and endothelial cell properties.
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Affiliation(s)
- S Mellander
- Department of Vascular Surgery, Wallenberg Laboratory, The Cardiovascular Institute, Sahlgrenska Academy, Göteborg, Sweden
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Börjesson M, Weidenhielm L, Mattsson E, Olsson E. Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study. Knee 2005; 12:121-7. [PMID: 15749447 DOI: 10.1016/j.knee.2004.04.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2004] [Revised: 03/10/2004] [Accepted: 04/08/2004] [Indexed: 02/02/2023]
Abstract
The aim of this prospective follow-up study was to determine if gait measurements and/or clinical measurements could detect differences in treatment outcome between two surgical interventions in patients with knee osteoarthritis (OA). The patients were followed for 5 years after surgery. Forty patients, 55-70 years of age, with unilateral knee OA were included. The patients were treated either with a high tibial osteotomy (HTO) (n=18) or a unicompartmental knee arthroplasty (UKA) (n=22). Clinical outcome measures were the British Orthopaedic Association (BOA) score, pain during walking, passive range of knee motion (PROM) and patients' subjective opinion. The gait variables were free walking speed, step frequency, step length and single and double-stance phase for each leg. The patients were examined before surgery and 3 months, 1 year and 5 years after surgery. The time-distance variables of gait could detect differences in treatment outcome, 3 months after surgery, while the clinical outcome measures, as given here, could not detect any differences between the two groups of patients. Measurements of free walking speed could be recommended for clinical evaluation, after surgical interventions, in patients with knee OA.
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Affiliation(s)
- M Börjesson
- Department of Neurotec, Division of Physiotherapy, Karolinska Institutet, Karolinska University Hospital Solna, S-171 76 Stockholm, Sweden.
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Abstract
The impact of physical activity on urinary leakage (UL) has previously been considered, but not in relation to first pregnancy and delivery. The aim of this study was to describe physical activity and urinary leakage before, during and after the first childbirth. The subjects who were invited to participate in the study were taken consecutively from nine maternity clinics in the northwest part of Stockholm County, and the study group included 665 primiparous women. The mean age of the women was 28 (range 17-43) years. The women answered one questionnaire during the 36th gestation week and another 1 year post partum. Physical activity/exercises were classified according to their impact on the pelvic floor, and the women were divided into three groups: high-impact exercise (n=327), low-impact exercise (n=84) and the inactive group (n=254). The results showed a high intensity and frequency of physical activity in the participating primiparous women. Risk factors for UL were symptoms of a dysfunctional pelvic floor and connective tissue disorders and high-impact physical activity before pregnancy, while low-impact activity seemed to promote continence. If urinary leakage was present before pregnancy, it persisted in most women during pregnancy and 1 year post partum.
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Affiliation(s)
- K Eliasson
- Department of Neurotec, Division of Physiotherapy, Karolinska Hospital, Karolinska Institutet, S-141 83 Stockholm, Sweden.
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Steffensen B, Hyde S, Lyager S, Mattsson E. Validity of the EK scale: a functional assessment of non-ambulatory individuals with Duchenne muscular dystrophy or spinal muscular atrophy. Physiother Res Int 2004; 6:119-34. [PMID: 11725594 DOI: 10.1002/pri.221] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE The EK scale comprises ten categories (EK 1-10), each contributing to an overall picture of function in the non-ambulatory stage of Duchenne muscular dystrophy (DMD). The purpose of the present study was to investigate content and construct validity of the EK scale as a tool to discriminate between levels of functional ability in individuals with DMD or spinal muscular atrophy (SMA) who were non-ambulatory. METHOD Data from a sample of 56 subjects with DMD and 38 with SMA, who were non-ambulatory, were obtained from four separate studies. The relationship of functional ability by use of the EK scale and (1) muscle strength, (2) contractures, (3) forced vital capacity and (4) years of wheelchair dependency were assessed. All items of the EK scale were used except the one representing severe hypoventilation. RESULTS Regression analyses showed that the EK sum was the most significant explanatory variable (p < 0.05) of all variables measured to explain muscle strength in both DMD and SMA subjects. The individual categories of EK (1-10) all contributed as significant explanatory variables (p < 0.05) to the other variables measured. CONCLUSIONS The categories and items of the EK scale were relevant and valid as means of discriminating between levels of functional performance in the population studied which was evidence of content and construct validity.
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Eliasson K, Nordlander I, Mattsson E, Larson B, Hammarström M. Prevalence of urinary leakage in nulliparous women with respect to physical activity and micturition habits. Int Urogynecol J 2004; 15:149-53. [PMID: 15167991 DOI: 10.1007/s00192-004-1135-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2003] [Accepted: 02/01/2004] [Indexed: 10/26/2022]
Abstract
In order to survey the influence of physical activity and micturition habits on urinary leakage (UL) in women before their first pregnancy, a study including 725 women attending nine maternity clinics in the northwest area of Stockholm was performed. During the 36th gestational week the women answered a questionnaire regarding the pre-pregnancy situation regarding UL, micturition habits and physical activity. Thirty-nine percent of the women, mean age of 28 (range 17-43) years, had experienced occasional UL. Of these, the majority (79%) had symptoms of stress urinary leakage and 21% had urge symptoms. Two percent were incontinent according to the definition of the International Continence Society (ICS). In a multivariate analysis age, inability to interrupt the urine flow and high-impact physical activity turned out to be independent risk factors for UL and thus should be observed together with traditional factors concerning UL in nulliparous women.
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Affiliation(s)
- K Eliasson
- Department of Neurotec, Karolinska Institutet, Karolinska Hospital, SE-14183, Huddinge, Sweden.
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Mattsson E, Herwald H, Egesten A. Superantigens from Staphylococcus aureus induce procoagulant activity and monocyte tissue factor expression in whole blood and mononuclear cells via IL-1 beta. J Thromb Haemost 2003; 1:2569-76. [PMID: 14675093 DOI: 10.1111/j.1538-7836.2003.00498.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Staphylococcus aureus is one of the most common bacteria in human sepsis, a condition in which the activation of blood coagulation plays a critical pathophysiological role. During severe sepsis and septic shock microthrombi and multiorgan dysfunction are observed as a result of bacterial interference with the host defense and coagulation systems. OBJECTIVES In the present study, staphylococcal superantigens were tested for their ability to induce procoagulant activity and tissue factor (TF) expression in human whole blood and in peripheral blood mononuclear cells. METHODS AND RESULTS Determination of clotting time showed that enterotoxin A, B and toxic shock syndrome toxin 1 from S. aureus induce procoagulant activity in whole blood and in mononuclear cells. The procoagulant activity was dependent on the expression of TF in monocytes since antibodies to TF inhibited the effect of the toxins and TF was detected on the surface of monocytes by flow cytometry. In the supernatants from staphylococcal toxin-stimulated mononuclear cells, interleukin (IL)-1 beta was detected by ELISA. Furthermore, the increased procoagulant activity and TF expression in monocytes induced by the staphylococcal toxins were inhibited in the presence of IL-1 receptor antagonist, a natural inhibitor of IL-1 beta. CONCLUSIONS The present study shows that superantigens from S. aureus activate the extrinsic coagulation pathway by inducing expression of TF in monocytes, and that the expression is mainly triggered by superantigen-induced IL-1 beta release.
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Affiliation(s)
- E Mattsson
- Department of Medical Microbiology, Dermatology, and Infection, Lund University Hospital, Lund, Sweden.
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Mattsson E, Sjödén P, von Essen L. 1260 Swedish mothers and fathers of a child diagnosed with cancer — a look at their quality of life. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)91286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Vrethem M, Mattsson E, Hebelka H, Leerbeck K, Osterberg A, Landtblom AM, Balla B, Nilsson H, Hultgren M, Brattström L, Kågedal B. Increased plasma homocysteine levels without signs of vitamin B12 deficiency in patients with multiple sclerosis assessed by blood and cerebrospinal fluid homocysteine and methylmalonic acid. Mult Scler 2003; 9:239-45. [PMID: 12814169 DOI: 10.1191/1352458503ms918oa] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if multiple sclerosis (MS) is associated with vitamin B12 (cobalamin) deficiency. METHODS We measured serum vitamin B12, plasma folate, serum methylmalonic acid (MMA), plasma homocysteine (tHcy) and also cerebrospinal fluid (CSF) MMA and tHcy in 72 patients with MS and 23 controls. RESULTS The mean plasma tHcy level was significantly increased in MS patients (11.6 micromol/L) compared with controls (7.4 micromol/L) (P = 0.002). Seven patients showed low serum vitamin B12 levels but only one of them had concomitant high plasma tHcy. None of them showed high serum MMA. Plasma or blood folate levels did not differ between MS patients and controls. We found no significant differences in mean values or frequency of pathological tests of serum B12, serum MMA, mean corpuscular volume (MCV), haemoglobin concentration, CSF tHcy or CSF MMA between patients and healthy subjects. There were no correlations between CSF and serum/plasma levels of MMA or tHcy. Serum vitamin B12, serum MMA, plasma tHcy, CSF Hcy or CSF MMA were not correlated to disability status, activity of disease, duration of disease or age. CONCLUSIONS The relevance of the increased mean value of plasma tHcy thus seems uncertain and does not indicate functional vitamin B12 deficiency. We can not, however, exclude the possibility of a genetically induced dysfunction of the homocysteine metabolism relevant for the development of neuroinflammation/degeneration. Our findings indicate that, regardless of a significant increase in plasma tHcy in MS patients, the MS disease is not generally associated with vitamin B12 deficiency since we did not find any other factors indicating vitamin B12 deficiency. Analysis of CSF MMA and CSF tHcy, which probably reflects the brain vitamin B12 status better than serum, are not warranted in MS. We conclude that B12 deficiency, in general, is not associated with MS.
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Affiliation(s)
- M Vrethem
- Department of Neuroscience and Locomotion, Division of Neurology and Neurophysiology, University Hospital, Linköping, Sweden.
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Abstract
The purpose of this study was to evaluate effects of a progressive strength training programme on walking ability in adults with cerebral palsy. Ten individuals with spastic diplegia (seven males, three females; mean age 31, range 23-44 years) participated twice a week over 10 weeks. Seven individuals with spastic diplegia (four males, three females; mean age 33, range 25-47 years) who did not receive strength training served as controls. All individuals were ambulatory but motor ability ranged from functional walkers to individuals who always required walking aids and used a wheelchair regularly. Significant improvements were seen in isometric strength (hip extensors p=0.006, hip abductors p=0.01), and in isokinetic concentric work at 30 degrees/s (knee extensors p=0.02) but not in eccentric work. Results also showed significant improvements in Gross Motor Function Measure (GMFM) dimensions D and E (p=0.005), walking velocity (p=0.005), and Timed Up and Go (p=0.01). There was no increase in spasticity for those who underwent strength training. Individuals in the control group did not show any significant improvement in any measured variable. The groups were small, however, and there was no significant difference between the groups in any measured variable. These findings suggest that a 10-week progressive strength training programme improves muscle strength and walking ability without increasing spasticity.
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Affiliation(s)
- C Andersson
- Karolinska Institutet, Neurotec Department, Division of Physiotherapy, Huddinge, Sweden.
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Abstract
OBJECTIVE Intimal hyperplasia develops in areas with low shear stress. The aim of the present study was to investigate if the mRNA expression of vascular endothelial growth factor (VEGF), Fms-like tyrosine kinase-1 receptor (Flt-1) and kinase insert domain-containing receptor (KDR) is regulated by shear stress. DESIGN Endothelial cells from human umbilical veins were in an in vitro system subjected to different levels of shear stress during 1 and 12 h. The mRNA expression of VEGF, Flt-1 and KDR was measured with RT-PCR. eNOS served as positive control and actin as housekeeping gene. RESULTS The KDR expression was isolated upregulated 3-4 times after 12 h exposure to high shear stress. CONCLUSION The genetic expression of KDR is upregulated by shear stress and this response is time dependent.
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Affiliation(s)
- T Staalesen
- Department of Vascular Surgery, The Wallenberg Laboratory, Bruna Stråket 11B, Plan 1, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Zachrisson H, Blomstrand C, Holm J, Mattsson E, Volkmann R. Changes in middle cerebral artery blood flow after carotid endarterectomy as monitored by transcranial Doppler. J Vasc Surg 2002; 36:285-90. [PMID: 12170208 DOI: 10.1067/mva.2002.125843] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE By using transcranial Doppler (TCD) it is possible to measure blood flow velocities within the circle of Willis. In this study, TCD was performed before and after carotid endarterectomy (CEA) with the aim to describe cerebral hemodynamics after normalization of the carotid artery blood flow. METHODS Thirty CEA patients were consecutively entered into the TCD study, whereas 15 patients were referred for postoperative TCD for various clinical reasons. All 45 patients were investigated by using TCD: first preoperatively, then during the first few days after CEA before discharge from the hospital, and finally 3 to 12 months later. In addition, all patients underwent duplex investigation of the internal carotid artery the day before surgery and 3 months postoperatively. For the analysis, the patients were divided into two groups, one with (S-group), suspected postoperative neurologic complications/symptoms and another one without (C-group). Six patients were assigned to the S-group and 37 to the C-group, the latter including two patients who underwent bilateral CEAs. RESULTS In the whole study group,a significant postoperative increase in systolic flow velocity was recorded bilaterally in the middle cerebral artery (MCA) as measured some days after surgery. The patients in the S-group showed high blood flow velocities mainly in the MCA on the ipsilateral side. A contralateral flow velocity increase did not occur in patients with very severe contralateral stenosis or occlusion (n = 9) if the late follow-up investigation was chosen as a reference value. Twenty patients in the C-group formed a subgroup with high blood pressure and/or headache postoperatively (CB-group) The other 19 patients were referred to as the CA-group. The CB- and S-groups showed more pronounced vessel disease in internal carotid artery on the contralateral side combined with lower collateral capacity in the circle of Willis compared to the CA-group. In the S-group the mean +/- standard deviation peak systolic velocity in ipsilateral MCA increased from a preoperative value of 0.71 +/- 0.22 m/sec to 2.23 +/- 0.72 m/sec (P <.005). In the CB-group, we observed a bilateral MCA blood flow velocity increase from 0.72 +/- 0.18 to 1.35 +/- 0.56 m/sec (P <.0001) on the ipsilateral side and from 0.82 +/- 0.37 to 1.28 +/- 0.66 m/sec (P < 0.001) on the contralateral side. In the CA-group, we observed minor bilateral blood flow velocity increases in the MCA, from 0.79 +/- 0.25 m/sec to 1.03 +/- 0.33 m/sec on the ipsilateral (P <.001) and from 0.70 +/- 0.17 m/sec to 0.93 +/- 0.26 m/sec on the contralateral side (P <.005). At the follow-up 3 to 12 months after surgery, the MCA flow velocities had returned to normal. CONCLUSIONS Soon after surgery, blood flow velocity increases often bilaterally in the MCA. However a contralateral flow velocity increase did not occur in patients with very severe contralateral stenosis or occlusion if the late follow-up investigation was chosen as a reference value. The clinical significance of bilateral flow velocity increases is uncertain, but very high blood flow velocities might be a signal for cerebrovascular hyperperfusion. In those patients, increased postoperative surveillance is recommended.
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Affiliation(s)
- H Zachrisson
- Department of Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Sandblom G, Holmberg L, Damber JE, Hugosson J, Johansson JE, Lundgren R, Mattsson E, Nilsson J, Varenhorst E. Prostate-specific antigen for prostate cancer staging in a population-based register. Scand J Urol Nephrol 2002; 36:99-105. [PMID: 12028682 DOI: 10.1080/003655902753679373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Previous studies have shown a relationship between serum prostate-specific antigen (PSA) level and prostate tumour volume. Reports based on selected case series have also indicated that serum PSA may be used for staging, although a varying prevalence of metastasizing tumours complicates the interpretation of these studies. In order to determine the accuracy of the serum level of PSA in predicting the presence of metastases we performed a prospective cohort study of a geographically defined population of men with prostate cancer. METHODS Serum level of PSA and the results of investigations for regional lymph node and distant metastases were recorded for all 8328 men with prostate cancer registered in the Swedish National Prostate Cancer Register 1996-1997. RESULTS The prevalence of lymph node metastases among men who had undergone lymph node exploration was 4%, 16% and 33% for well, moderately and poorly differentiated tumours. The corresponding prevalence of distant metastases was 12%, 30% and 48%. With serum PSA <20 ng/ml as a cut-off point the negative likelihood ratios for well and moderately differentiated tumours were found to be 0.47 and 0.45 for lymph node metastases and 0.24 and 0.18 for distant metastases, resulting in post-test probabilities >92% for the exclusion of metastases. In men with poorly differentiated tumours, the negative likelihood ratio would need to be even lower to safely exclude disseminated disease. CONCLUSION For well to moderately differentiated tumours, further investigations to assess the presence of metastases may be omitted with no great risk for understaging if serum PSA <20 ng/ml.
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Affiliation(s)
- G Sandblom
- Department of Urology, Faculty of Health Sciences, University Hospital of Linköping, SE-581 85 Linköping, Sweden.
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Sandblom G, Holmberg L, Damber JE, Hugosson J, Johansson JE, Lundgren R, Mattsson E, Nilsson J, Varenhorst E. Prostate-specific antigen as surrogate for characterizing prostate cancer subgroups. Scand J Urol Nephrol 2002; 36:106-12. [PMID: 12028683 DOI: 10.1080/003655902753679382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate how serum prostate-specific antigen (PSA) levels in a population-based cohort of men with prostate cancer vary with age and intensity in the diagnostic activity and to describe the treatment selection processes associated with PSA level. MATERIAL AND METHODS All men in the Swedish National Prostate Cancer Register diagnosed during 1996-1997 were included. In 1996 the register included 19 counties, covering 61% of the Swedish male population, and in 1997 21 counties with 79% of the Swedish male population. RESULTS A total of 8328 men were registered. PSA levels were missing in 341 cases. With increasing PSA there was a shift towards more advanced and poorly differentiated tumours. PSA at diagnosis increased with age, with the exception of patients younger than 50 years who had higher PSA values. The mean logarithm of PSA correlated negatively with the percentage of localized tumours (p < 0.005) and the age-adjusted incidence (p < 0.05) in each respective county in 1997. PSA was higher in men receiving radiotherapy compared with those treated with radical prostatectomy as well as in the group treated with bilateral orchiectomy compared with those receiving GnRH-analogues. CONCLUSIONS If PSA is used as a surrogate measure of extent of tumour volume in a population of prostate cancer patients, our findings indicate that age distribution and differences in incidence (possibly due to variation in diagnostic activity) should be taken into account. In our cohort there was a selection process, probably in part guided by PSA level, when choosing type of curative or palliative treatment.
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Affiliation(s)
- G Sandblom
- Department of Urology, Faculty of Health Sciences, University Hospital of Linköping, SE-581 85 Linköping, Sweden.
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Abstract
During trampoline jumping the pelvic floor is exposed to high forces. There has been a general belief that physically fit women have a strong pelvic floor as a result of their regular training, thus preventing urinary incontinence. The aim of this study was to survey the prevalence of stress urinary incontinence in female elite trampolinists. The prevalence of urinary incontinence was assessed by a questionnaire, sent to all 35 elite trampolinists (mean age 15, range 12-22 years) in Sweden. Eighty percent of the trampolinists reported involuntary urinary leakage, but only during trampoline training. The leakage started after 2.5 (range 1-4) years of training. Age (P < 0.001), duration of training (P = 0.04), and training frequency (P = 0.01) were significantly associated with leakage. All women above 15 years of age (n = 23) reported urinary leakage (P < 0.001). Eighteen incontinent women continued the study and their leakage was verified by a pad test. The leakage averaged 28 g during a jump session. The muscle strength was measured with perineometry in 10 women and showed good strength in the pelvic floor muscles.
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Affiliation(s)
- K Eliasson
- Department of Physical Therapy, Karolinska Institutet, S-14157 Huddinge, Sweden
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Larsson UE, Mattsson E. Perceived disability and observed functional limitations in obese women. Int J Obes (Lond) 2001; 25:1705-12. [PMID: 11753594 DOI: 10.1038/sj.ijo.0801805] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2001] [Revised: 04/10/2001] [Accepted: 05/02/2001] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe perceived disability in obese women. DESIGN Comparisons of perceived disability in obese women and in a normal-weight reference group regarding activities of daily life (ADL), mobility, housework and professional work as well as comparisons of perceived disability and observed functional limitations reported in a previous study. SUBJECTS Fifty-seven consecutively selected obese female outpatients, mean age 44 y (body mass index (BMI) 37 kg/m2) and 22 voluntary referents, mean age 49 y (BMI 22 kg/m2). MAIN OUTCOME MEASURES A pain questionnaire (for background data) and a disability questionnaire, which is new, detailed and specific with test-retest stability and content- and criterion-referenced validity. Comparisons of results from the questionnaire and a functional test regarding observations of similar functional limitations. RESULTS The obese women perceived disability to a much higher extent (P<0.003) than did the normal-weight women. The main problems concerned occupational work in strenuous positions, strain and pain, sports, walking outdoors or on stairs, and moderate housework requiring squatting, stooping or lifting. Rising from sofas, pedicure and stress incontinence were problematic. The correlation between perceived disability and functional limitations was fairly good (r(s)=0.56) but ranged widely (r(s)=0.14-0.61). Within the group of obese women the disability neither correlated to BMI nor age, rather to lower-body pain. CONCLUSION The disability questionnaire conveyed new and detailed information of disability problems in everyday life in obese women. It highlighted the difference between the disability these women may perceive and the functional limitations we can observe and measure. This result is of great clinical relevance in the care of obese women.
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Affiliation(s)
- U E Larsson
- Department of Physical Therapy, Karolinska Institutet, Huddinge, Sweden.
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Klefbeck B, Svartengren K, Camner P, Philipson K, Svartengren M, Sejersen T, Mattsson E. Lung clearance in children with Duchenne muscular dystrophy or spinal muscular atrophy with and without CPAP (continuous positive airway pressure). Exp Lung Res 2001; 27:469-84. [PMID: 11558965 DOI: 10.1080/019021401750414010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Bronchiolar clearance was studied in 7 boys in the age range of 8 to 17 years, 6 with Duchenne muscular dystrophy (DMD) and 1 with spinal muscular atrophy type II (SMA-II). These boys had healthy lungs but a severely reduced muscular strength (wheelchair dependent). In 6 of the boys, clearance was studied twice, at one occasion as a control and at the other occasion following treatment with continuous positive airway pressure (CPAP). A control group of healthy adults was used. In the clearance examinations, 6-microm Teflon particles, labeled with III In was inhaled extremely slowly, 0.05 L/s. This gives a deposition mainly in the bronchioles. Lung retention was measured after 0,24,48, and 72 hours. A model for deposition of particles in the adult lung was scaled down to represent the children in this study. Deposition in various airway generations was calculated to be similar in children and adults. Also the measured retentions were similar in the boys and the adults. In the clearance experiments during CPAP treatment, there was a significantly lower retention after 72 hours (but not after 24 and 48 hours) than in the control experiments. Theresults indicate that a severe reduction of muscular strength, and thereby a reduction of mechanical movement of the lung, does not affect clearance from large and small airways. However, some effect of clearance from small airways cannot be excluded due to the short measuring period. The small but significant effect of the CPAP treatment might have potential clinical importance and suggest that bronchiolar clearance can be affected by some form of mechanical force.
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Affiliation(s)
- B Klefbeck
- Department of Physical Therapy, Karolinska Institutet, Stockholm, Sweden.
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Greiff L, Petersen H, Mattsson E, Andersson M, Erjefält JS, Linden M, Svensson C, Persson CG. Mucosal output of eotaxin in allergic rhinitis and its attenuation by topical glucocorticosteroid treatment. Clin Exp Allergy 2001; 31:1321-7. [PMID: 11529904 DOI: 10.1046/j.1365-2222.2001.01029.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Eotaxin is a chemokine that attracts and activates eosinophils. The present study examines the occurrence of eotaxin in nasal mucosal surface liquids in patients with seasonal allergic rhinitis without allergen exposure and during repeat allergen challenge with and without topical glucocorticosteroid treatment. The number of subepithelial eosinophils and mucosal outputs of bulk plasma (alpha2-macroglobulin) and eosinophil cationic protein (ECP) are also examined. METHODS Twelve patients underwent daily allergen challenges for 6 days. Separately, 14 patients, who were receiving budesonide and placebo in a parallel group design, also underwent allergen challenge for 6 days. Nasal biopsies were obtained before and 24 h after the allergen challenge series, and lavages were carried out before and 15 min after selected allergen challenges. RESULTS At baseline nasal lavage fluid levels of eotaxin correlated to levels of alpha2-macroglobulin and ECP. After the first allergen challenge there was a correlation between nasal lavage fluid levels of eotaxin and ECP. Repeat allergen exposure increased the mucosal output of eotaxin (P <0.05) and ECP (P <0.01) as well as eosinophil numbers (P <0.01), but no correlation was found between increased eosinophil numbers and eotaxin. Budesonide reduced eotaxin levels during repeat allergen challenge (P <0.05). CONCLUSIONS Repeat allergen exposure in allergic rhinitis is associated with increased mucosal output of eotaxin. Topical budesonide attenuates this effect, suggesting the possibility that inhibitory effects on mucosal eotaxin may contribute to anti-eosinophilic actions of topical glucocorticosteroids.
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Affiliation(s)
- L Greiff
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Lund, Sweden.
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Abstract
Staphylococcus aureus is a prominent human pathogen. Here we report that intact S. aureus bacteria activate the contact system in human plasma in vitro, resulting in a massive release of the potent proinflammatory and vasoactive peptide bradykinin. In contrast, no such effect was recorded with Streptococcus pneumoniae. In the activation of the contact system, blood coagulation factor XII and plasma kallikrein play central roles, and a specific inhibitor of these serine proteinases inhibited the release of bradykinin by S. aureus in human plasma. Furthermore, fragments of the cofactor H-kininogen of the contact system efficiently blocked bradykinin release. The results suggest that activation of the contact system at the surface of S. aureus and the subsequent release of bradykinin could contribute to the hypovolemic hypotension seen in patients with severe S. aureus sepsis. The data also suggest that the contact system could be used as a target in the treatment of S. aureus infections.
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Affiliation(s)
- E Mattsson
- Department of Cell and Molecular Biology, Lund University, Sweden.
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Evers Larsson U, Mattsson E. Functional limitations linked to high body mass index, age and current pain in obese women. Int J Obes (Lond) 2001; 25:893-9. [PMID: 11439305 DOI: 10.1038/sj.ijo.0801553] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2000] [Revised: 09/04/2000] [Accepted: 10/09/2000] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe functional limitations in obese women. DESIGN Comparisons of functional limitations in obese women and in a normal-weight reference group regarding mobility, balance and housework transport. SETTING A large room with a corridor and staircase nearby. SUBJECTS Fifty-seven consecutively selected obese female outpatients, mean age 44 y, body mass index (BMI) 37 kg.m(-2), and 22 voluntary references, mean age 49 y, BMI 22 kg.m(-2). MAIN OUTCOME MEASURES Pain questionnaire (for background data); a new valid and reliable test protocol measuring activities of daily life (ADL), pain and exertion, heart rate, balance and speed. RESULTS The patients had problems in performing 13 of 16 actions compared with the references (P-values between 0.05 and 0.001). They moved more slowly and had difficulties and /or pain and exertion in flexibility tasks, balancing, activities at floor level (bending and kneeling), climbing stairs and carrying groceries. BMI (P=0.002), age (P=0.02) and current pain (P=0.02) from the lower body predicted functional limitation. CONCLUSIONS The functional test reflected functional limitations in obese women, revealing difficulties and perceived pain in ADL. The test protocol can be used to evaluate the effects of training or dieting. For clinical use we recommend considering BMI, age and current pain for use when individualizing advice on training.
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Affiliation(s)
- U Evers Larsson
- Department of Physical Therapy, Karolinska Institutet, S-141 57 Huddinge, Sweden.
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Abstract
The purpose of this study was to describe problems and resources of adults with cerebral palsy (CP) with special emphasis on locomotion. A questionnaire concerning demographic facts, locomotion, musculoskeletal problems, and present physical activity was mailed to 363 adults with CP. Two hundred and twenty-one adults, (125 male and 96 female; mean age 36 years, range 20 to 58 years) answered the questionnaire. Seventy-seven per cent reported problems with spasticity. Eighty-four per cent lived in their own apartments, with or without home services. Twenty-four per cent worked full-time and 18% had full disability pension. Twenty-seven per cent had never been able to walk, 64% could walk with or without walking aids, 35% reported decreased walking ability, and 9% had stopped walking. Eighty per cent reported contractures and 18% had pain every day. Approximately 60% were regularly physically active, and despite their disability, 54% considered that they were not limited in their ability to move about in the community.
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Affiliation(s)
- C Andersson
- Department of Physical Therapy, Karolinska Institutet, Huddinge, Sweden.
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Ståhle A, Lindquist I, Mattsson E. Important factors for physical activity among elderly patients one year after an acute myocardial infarction. Scand J Rehabil Med 2000; 32:111-6. [PMID: 11028795 DOI: 10.1080/003655000750045451] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The aim of this study was to identify and describe the factors of importance for elderly (> or =65 years) patients in being physically active one year after acute myocardial infarction. Forty-three consecutive elderly patients with a recent myocardial infarction were randomized either to a supervised outpatient-group training programme, 50 min three times a week for 3 months, or to a control group. An independent observer interviewed the patients 12 months after randomization in order to elucidate the factors that motivated the patients into being physically active. Both groups were identical at the start. The patients in the training group stated that the programme had made them more self-confident regarding physical activities and this seems to be an important factor for continuing to be physically active. Body mass index, age, gender and support from a physically active partner were of minor importance compared to the training programme or earlier experience of regular physical activity.
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Affiliation(s)
- A Ståhle
- Department of Physical Therapy, Karolinska Hospital, Stockholm, Sweden.
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Abstract
OBJECTIVE To evaluate whether inspiratory muscle training in patients with prior poliomyelitis (and with symptoms and signs of hypoventilation) who use part-time assisted ventilation could improve symptoms and respiratory muscle function without adverse effects. DESIGN Intervention study with before-after trial. SETTING Training was performed in the patients' homes; assessments were performed at the hospital. PATIENTS Ten prior-polio patients were included. Three of them did not complete the trial, and their data were not included in results of training. INTERVENTION Ten weeks of daily inspiratory muscle training. MAIN OUTCOME MEASURES Spirometry, maximal inspiratory and expiratory pressures, inspiratory muscle endurance, and questions regarding activities of daily living were performed. RESULTS Inspiratory endurance capacity over 5 minutes improved from 10.7 to 16.7cm H2O (p < .05) assessed at 15 on the Borg scale, and most patients improved in activities of daily living. The whole-body endurance capacity remained stable over the studied period. CONCLUSION Inspiratory muscle training and close supervision can increase respiratory muscle endurance and improve well-being in patients with prior polio who use part-time assisted ventilation.
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Affiliation(s)
- B Klefbeck
- Department of Physical Therapy, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden
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Abstract
Hemodilution has previously been shown to improve microcirculation in skeletal muscle after ischemia. We have studied the effects of isovolemic hemodilution with dextran on the function of anterior tibial muscle in the rabbit. Hemodiluted (hematocrit 28%) and nonhemodiluted animals were compared. Hemodilution led to an immediate increase in femoral blood flow. Flow normalized within 1-2 h, possibly due to flow redistribution. Hemodilution increased muscle force by 10%, which can reflect alterations in blood chemical composition or an improved microcirculation. Unilateral hindlimb ischemia induced by arterial occlusion inhibited muscle force to less than 15% in 150 min. Force and blood flow recovered almost completely after ischemia. After longer ischemia (170-300 min) when force was <5%, muscles did not recover. Hemodilution did not alter the muscle force or the extent or rate of force recovery after ischemia, which shows that the increased blood flow and improved microcirculation are not directly associated with changes in the sensitivity of muscle function to ischemia.
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Affiliation(s)
- L Frost-Arner
- Department of Plastic and Reconstructive Surgery, Malmö University Hospital, Sweden
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Sandblom G, Mattsson E, Nilsson J, Damber JE, Johansson JE, Lundgren R, Varenhorst E. Prostate cancer registration in four Swedish regions 1996-- differences in incidence, age structure and management. Scand J Urol Nephrol 1999; 33:306-11. [PMID: 10572993 DOI: 10.1080/003655999750017374] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In 1996 registration of prostate cancer in four of the six Swedish regions was started to facilitate evaluation of geographical variations in incidence and treatment. MATERIAL AND METHODS For all cases of prostate cancer, personal identification number, tumour stage, tumour grade and primary treatment were registered. RESULTS In the four regions covered by the register, 3541 cases of prostate cancer were registered. Altogether there were 5795 cases of prostate cancer diagnosed in Sweden the same year. The age-standardized incidence varied from 89/100000 to 169/100000 among counties. The proportion of localized tumours correlated positively to the incidence (p < 0.05) and negatively to mean age at diagnosis (p < 0.01). There was also a significant positive correlation between the proportion of localized tumours and the percentage of patients given curative treatment. All registered variables showed large geographical variations, especially concerning percentage of T1c tumours, treatment of localized tumours and choice of palliative treatment. CONCLUSION Diagnostic activity varied considerably among counties, resulting in large variation in age-standardized incidence. High incidence is associated with a larger proportion of localized tumours, which, in turn, is associated with early age at diagnosis. In counties where a policy of detecting tumours early is practised, curative treatment is also given more often. Treatment of localized tumours and preference for palliative treatment seem to depend on local traditions. The lack of cytological and histopathological standards makes geographical comparisons based on tumour grade impossible.
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Affiliation(s)
- G Sandblom
- Department of Surgery, Motala Hospital, Sweden.
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Ståhle A, Mattsson E, Rydén L, Unden A, Nordlander R. Improved physical fitness and quality of life following training of elderly patients after acute coronary events. A 1 year follow-up randomized controlled study. Eur Heart J 1999; 20:1475-84. [PMID: 10493846 DOI: 10.1053/euhj.1999.1581] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Cardiac rehabilitation including exercise training is of proven value in ischaemic heart disease. However, elderly patients frequently are not encouraged to participate in such programmes. This study evaluates the physiological effects and self-reported quality of life after an aerobic outpatient group-training programme in subjects above the age of 65 years. METHODS AND RESULTS A consecutive series of 101 patients (males 80%) aged 65-84 (mean 71) years recovering from an acute coronary event were randomized to either a supervised out patient group-training programme (n=50) or to a control group (n=51). The two groups were well balanced as regards clinical characteristics. The compliance in the training group was 87%. Exercise tolerance increased in the trained group from 104 to 122 and 111 W after 3 and 12 months respectively. The corresponding values were 102, 105 and 105 W among controls. Parameters, such as quality of life, self-estimated level of physical activity, fitness and well-being were graded higher by the trained patients than those who served as controls on the two occasions of follow-up. CONCLUSIONS Aerobic group-training of elderly patients recovering from an acute coronary event beneficially influences physical fitness and several parameters expressing quality of life. Great care has to be taken to preserve the initial effects by continued training.
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Affiliation(s)
- A Ståhle
- Departments of Physical Therapy, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden
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